This invention claims priority of the Swiss patent application No. 2383/99 which is incorporated by reference herein.
The invention concerns a combination of a magnification device, in particular a microscope, with a measurement device, in particular a diagnostic device, usable during an operation on or examination of a specimen, which in particular is a human or animal body part or organ (part), performed with the magnification device or the microscope.
The invention concerns in particular a device for use during the performance of operations on the human or animal eye with a magnification device, in particular with a surgical microscope which comprises an objective system and optical devices for viewing the eye through an eyepiece system. The invention also concerns a surgical microscope for performing operations on the human or animal eye.
Examination microscopes, surgical microscopes, and other magnification devices and diagnostic units for examination and for performing operations on various organs and organ parts are known in a number of embodiments. Some of these known units are those that are used in the performance of ophthalmic operations or for the examination of eyes.
Reference will be made hereinafter especially to microscopes or surgical microscopes, the invention not being limited thereto. In particular, these also include other magnification devices, such as loupes or the like, for observing or magnifying an object or surgical field or the like.
For example, a number of surgical microscopes for performing ophthalmic operations are known from the existing art. U.S. Pat. No. 5,135,299, for example, discloses a surgical microscope in which there is provided a special optical illumination system which is arranged and configured in such a way that the axis of the beam path of the illumination system does not coincide with the optical axis of the microscope. U.S. Pat. No. 5,321,447 concerns a surgical microscope for performing ophthalmic operations which can selectably be equipped with an ophthalmoscopy attachment that effects image erection of the intermediate image produced by an ophthalmoscope lens, transposes the observation beam paths, and allows the surgical microscope to be used selectably in conventional fashion or as an ophthalmoscope, with no need to make modifications to the surgical microscope.
Devices for the examination of eyes are, for example, tonometers, which once again exist in various embodiments. Current standard tonometers ascertain intraocular pressure by means of a narrow jet of air that is blown onto the eye, its effects on the ocular surface being ascertained. As is known, for example, from U.S. Pat. No. 5,474,066, it is possible to use for this purpose an optical unit with which the eye is illuminated and the light reflected from the eye is detected. The intraocular pressure thus ascertained is indicated on a display.
Tonometers that operate with ultrasonic waves instead of air have also already been proposed, for example in U.S. Pat. No. 5,636,635.
It is furthermore known to combine with one another diagnostic units that ascertain or determine different measurement or examination data of the eye. A combination of a tonometer with a second diagnostic unit for examining the back of the eye is known, for example, from U.S. Pat. No. 5,523,808. The tonometer used here works with air that is blown onto the cornea through a nozzle positioned in front of the eye. The nozzle blows air onto the eye in a position that lies slightly outside the optical axis of the second optical examination device. Because of the curvature of the cornea, the latter is acted upon with air substantially perpendicularly.
In certain ophthalmic operations, the danger exists that inadvertent damage may occur, for example, to the retina. This can be the case, for example, if the administration of certain medications can result in an elevation of intraocular pressure, if an operation is performed on the eye of a person who is already exhibiting elevated intraocular pressure, or also directly in conjunction with the operation. Intraocular pressure is therefore also measured before each operation.
In many operations or examinations, it is fundamentally desirable to have available certain parameters of the specimen in question that cannot be ascertained by way of the particular surgical method or examination method, so that the operation or examination can be performed as optimally as possible, in particular without endangering the patient or the specimen being examined. A solution to this problem is therefore the fundamental object of the invention.
In particular, it is the object of the invention to be able to prevent, at least in most cases, the occurrence of damage to the eye during an operation as a consequence of intraocular pressure.
The basic object is achieved, according to the present invention, in that during the operation or examination, specimen data that are ascertained or determined by the measurement device are directly displayable in the microscope as an optical signal; and/or that in the event the measured data of the specimen exceed or fall below threshold values and/or interval values, especially as a function of further parameters such as time or temperature, a warning signal is triggerable by way of which further actions, such as shutdown or switchover actions, can be automatically executed as applicable.
As far as the performance of ophthalmic operations is concerned, the stated object is achieved, according to the present invention, in that in combination with the microscope a tonometer for measuring and ascertaining intraocular pressure during the operation is provided; and that either the surgical microscope comprises an apparatus for reflecting into the eyepiece system at least one optical signal that is correlated with the intraocular pressure, or the tonometer, upon occurrence of a pathological intraocular pressure value, emits a signal that is audible in the microscope area.
In novel fashion and according to the present invention, therefore, simultaneous measurement of the eye or specimen occurs during observation thereof through the magnification device.
One design of a surgical microscope configured according to the present invention comprises a device with which at least one optical signal that correlates with data concerning the intraocular pressure of the eye presently being operated on can be reflected into the eyepiece system.
The invention allows a modification of the manipulating technique of the microscopically observing entity or operating entity in accordance with the situation. This can be, for example, automatic stoppage of the procedure in question, for example the surgical intervention. In this context, let it be mentioned that the term xe2x80x9cmicroscopically observing entityxe2x80x9d or xe2x80x9coperating entityxe2x80x9d is to be understood not only as a person (a surgeon) but also as a micromanipulator or a robot, the latter also, as a rule, forwarding optical data and signals via telecommunications to an observing or controlling person.
In the context of ophthalmic operations in particular, the invention permits the operator to ascertain and observe the intraocular pressure and its changes during the operation and to react promptly when necessary, whether by administering medications or by taking other appropriate actions.
According to a preferred embodiment of the invention, the optical signal is reflected in from outside. This simplifies the construction of the entire device and the construction of the optical device required in the surgical microscope for reflection.
In one of the variant embodiments of the invention, the optical signal can be the measured value ascertained by the tonometer and displayed on a display. The operator is thereby given the capability of reading, in the microscope, the measured value that is actually being ascertained.
In a further variant embodiment of the invention, the optical signal is the light of a warning lamp. This very simple embodiment, requiring little complexity, is also favorable for the operator, since he or she needs to pay attention only to the light of a warning lamp. One economical and reliable embodiment provides for the light to be a spot of light, in particular an LED display.
In order to give the operator the opportunity to concentrate entirely on his or her activity, it is advantageous if the optical signal is reflected in only if a value exceeds or falls below a previously established threshold.
Alternatively or additionally, according to a further variant embodiment of the invention provision can be made for the optical signal to change color conspicuously (e.g. green, yellow, red) in the event a value exceeds or falls below a previously established threshold. This feature as well makes it easy for the operator to observe the signal.
Another contribution to a simple and reliable configuration for the entire device and the surgical microscope is made if the display and the warning light are directly coupled to the tonometer in terms of data.
In order to direct the operator""s attention to an even greater degree to a situation that may be dangerous, provision can further be made for the optical signal to be combined with an acoustic signal; or for the acoustic signal to occur instead of an optical signal.